Out-of-Pocket Health Spending Between Low- and Higher-Income Populations

Shen, Yu‐Chu; McFeeters, Joshua

doi:10.1097/01.mlr.0000199692.78295.7c

Cited by 60 publications

(53 citation statements)

References 12 publications

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“…At the end of 1996, the experiment reform was extended to 57 other cities, and in December 1998 the government called for reform of the existing GIS and LIS in China's remaining cities. By the end of 2003, the vast majority of large cities had implemented 2 Waters et al (2004), Shen andMcFeeters (2006) andO'Donnell et al (2005) look at the impacts of insurance on a binary variable capturing especially large spending. None, however, captures the endogeneity of insurance.…”

Section: Health Insurance In China-some Salient Factsmentioning

confidence: 99%

“…Often these are tabulations of spending by insurance status or cross-section regressions of spending on insurance status and other covariates: examples from the US, which find higher out-of-pocket spending among the insured, include Rubin and Koelln (1993), Waters et al (2004) and Shen and McFeeters (2006). 1 Such studies are vulnerable to biases caused by health insurance being endogenous.…”

Section: Introductionmentioning

confidence: 99%

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Can insurance increase financial risk?

Wagstaff

Lindelöw

2008

Journal of Health Economics

347

109

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Section: Health Insurance In China-some Salient Factsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Can insurance increase financial risk?

Wagstaff

Lindelöw

2008

Journal of Health Economics

347

109

View full text Add to dashboard Cite

“…To date, though, only a few studies (e.g. Sesma-Vazquez et al 2005;Shen and McFeeters 2006;Habibov 2010;Okunade et al 2010; Amaya Lara and Ruiz Gomez 2011) have investigated factors associated with out-of-pocket expenditures (OOPE) and catastrophic expenditures (CE). Also, none of the previous studies examined the issues of OOPE and CE in the Iranian health care system.…”

Section: Introductionmentioning

confidence: 98%

Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments?

Hajizadeh

Nghiem

2011

Int J Health Care Finance Econ

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Since the beginning of 1980s, the Iranian health care system has undergone several reforms designed to increase accessibility of health services. Notwithstanding these reforms, out-of-pocket payments which create a barrier to access health services contribute almost half of total health are financing in Iran. This study aimed to provide a greater understanding about the inequality and determinants of the out-of-pocket expenditure (OOPE) and the related catastrophic expenditure (CE) for hospital services in Iran using a nationwide survey data, the 2003 Utilisation of Health Services Survey (UHSS). The concentration index and the Heckman selection model were used to assess inequality and factors associated with these expenditures. Inequality analysis suggests that the CE is concentrated among households in lower socioeconomic levels. The results of the Heckman selection model indicate that factors such as length of stay, admission to a hospital owned by private sector or Ministry of Health and Medical Education, and living in remote areas are positively associated with higher OOPE. Results of the ordered-probit selection model demonstrate that length of stay, lower household wealth index, and admission to a private hospital are major factors contributing to the increase in the probability of CE. Also, we find that households living in East Azarbaijan, Kordestan and Sistan and Balochestan face a higher level of CE. Based on our findings, the current employer-sponsored health insurance system does not offer equal protection against hospital expenditure in Iran. It seems that a single universal health insurance scheme that covers health services for all Iranian-regardless of their employment status-can better protect households from catastrophic health spending.

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“…This argument is unquestionably correct; however, our study suggests that the overall broader coverage generally available through an employment group is more in line with the needs of individuals who, because of their health conditions, enroll in high-risk pools. Shen and McFeeters (2006) found that regardless of income levels, adults with private, nongroup coverage had the highest risk of incurring high out-of-pocket expenses (. $2,000/year) and bearing a high financial burden (out-of-pocket costs exceeding 5% of income).…”

Section: Discussionmentioning

confidence: 99%

Does High-Risk Pool Coverage Meet the Needs of People at Risk for Disability?

Hall

Moore²

2008

INQUIRY

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State high-risk insurance pools serve people denied coverage because of pre-existing conditions. With benefit plans modeled on the individual market, these pools generally require higher out-of-pocket expenditures and provide fewer benefits than employer-sponsored plans, while their beneficiaries have very intensive needs. We profile 416 working adults enrolled in a state high-risk pool and document their health conditions and health care utilization. High-risk pool and federal employee benefits are compared to assess insurance structure and implications for health and disability outcomes.

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Out-of-Pocket Health Spending Between Low- and Higher-Income Populations

Cited by 60 publications

References 12 publications

Can insurance increase financial risk?

Can insurance increase financial risk?

Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments?

Does High-Risk Pool Coverage Meet the Needs of People at Risk for Disability?

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